The industry’s evolution from fee-for-service to value-based care represents a challenge to traditional healthcare business models. Today’s healthcare providers need to adapt to new ways of thinking and operating. We help health care delivery organizations identify, understand, and act on emerging opportunities to transform their operations and improve their clinical and financial performance.
DIY Workflow and Report Design. Our applications are built for self-service, reducing or eliminating the need for consultants and system integrators to customize our software to your needs. Launch our apps, and realize value immediately.
High Accolades for Customer Satisfaction. We hold high accolades for customer satisfaction. Our applications have been named Best in KLAS for three years, and in 2021 we are cited for excellence by KLAS Research for customer satisfaction and partnerships.
A Legacy of Innovation. We bring a 30-year legacy of HIT innovation. Our software and services were developed by providers, for providers. We were among the first to combine technology and services to administer bundled payments, and the first to codify medical evidence as algorithms to evaluate clinical data and display it as decision support in the EHR.
Success in value-based care hinges on alignment between analytics insights and care team activities. Analytics-guided care coordination and clinical decision support ensures that care gaps and treatment opportunities that represent the greatest clinical and financial impact are addressed during in-person and virtual points of care. Care coordination and care delivery applications simplify and expedite treatment decisions and workflows, ensuring priority interventions are addressed, while minimizing variations in care.Learn More
Addressing care gaps in the patient population is a proven way to improve population health while increasing reimbursement potential under fee-for-service and value-based payment models. Our care coordination and delivery solutions increase the efficacy of care teams by identifying cohorts with the care gaps that align with payer contract parameters.
Healthcare delivery organizations across the country are faced with a provider burnout epidemic stemming from inefficient processes that require manual repetition. Our solutions, designed by providers for providers, help care coordinators spend less time doing redundant tasks though role-based tasking features. This ensures activities are assigned to the appropriate team member, enabling top-of license work.
For value-based care, maximizing virtual and in-person office visits means addressing as many care gaps as possible. Our clinical decision support tools surface treatment and prevention opportunities at a glance through an award-winning dashboard, used by providers during interactions with patients.
Reducing click fatigue and redundant task is one way of reducing provider burnout. Our clinical decision support tools can embed in the EHR and feature bi-directional data integration. This keeps providers within the established workflows and reduces the need to enter the same data into multiple systems.
To remain competitive and profitable amid declining fee-for-service revenue, healthcare delivery organizations can access new patients and lines of business by developing high-performance provider networks that align with alternative payment models, like bundled payments. Our bundles administration applications and services include bundles design, network development, credentialing and contracting, and value-based care payment administration. Our tools, consulting and outsourced services can help position your healthcare delivery organization for new business as employers seek to engage directly with providers in centers of excellent and high performing, primary care networks.Learn More
Providers with capabilities to manage alternative payment models will be better prepared as value-based care delivery eclipses traditional fee-for-service. Our administrative tools and for bundles claims adjudication will meet you where you are on the value journey. Use our tools to design your own agreements, engage us for a spot engagement to solve a specific problem, or contract with Cedar Gate for a complete business process outsourcing solution.
Creating a high-performance provider network requires access to data, analytics, and partner relationships. For provider groups lacking one or all of these competencies, we offer a design-build service that organizes networks based on the characteristics of a specific geographic region. This helps providers promote high-quality services for direct-to-employer arrangements such as COEs, and high-performing primary care networks.
Data is becoming more interoperable and more accessible, but interpreting the cost and quality data points to design successful bundles requires sophisticated analysis. Our bundles design tools will prospectively identify procedure opportunities based on volume, payment variability, spend and impact. It works continuously works to optimize bundle programs through revenue and volume opportunity analysis. And, if you are doing what-if analysis, we can analyze performance retrospectively, as if a bundled payment agreement had been in place.
For organizations seeking turn-key bundles solutions, we offer comprehensive bundles business process outsourcing services, including contract design, operation, and optimization. To help ensure success, we leverage a spectrum of capabilities, including value-based care analytics, bundles claims processing, and professional consulting and managed services for ongoing program improvement.
An independent physician association (IPA) client faced a challenge connecting and supporting a large, geographically dispersed provider network—comprised of 3,550 physicians and 1,300 Medicare Advantage (MA) providers—with a very diverse patient population. This IPA’s goal was to remain profitable, while improving administrative and care management efficiency in state Medicaid and Medicare programs, and to grow in market share.
Read Full Story
Independent physician associations and managed services organizations handling delegated risk agreements are faced with inefficient and inaccurate claims management, resulting in higher operational costs. Our capitation administration applications feature self-service tools that automate and increase precision of the repetitive tasks of claims data management, payment processing, and reimbursement.Learn More
Multiple capitated contracts and fee schedules across various lines of business increase the likelihood of administrative errors. Our core administrative processing system features automated processes that help ensure correct coding, grouping, pricing, and payment. It automatically attaches authorizations to the claim, generates letters, adjudicates the claims, and tracks activity for compliance reporting.
Systems able to accommodate diverse payment models allow clients to minimize software expenses. Our claims administration solution can take on capitated and fee-for-service payment agreements.
Unpredictable and often delayed cash collections create financial challenges for the organization, including overreliance on lines of credit. Our financial management tools pinpoint variation in payment, enabling clients to identify problems within the process and take action.
Processes such as authorizations and referrals are time and resource intensive. Our capitation administration application determines eligibility and matches auto-adjudication tables to approve or deny authorizations and generates the corresponding letter.
The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you. Learn more today!